Skin symposium highlights

Elizabeth Harris
Clinical Nurse Specialist Stoma Care, Royal Berkshire Hospital, UK

  • Maintaining healthy peristomal skin is essential to ensuring successful adhesion of the skin barrier.1
    - If skin becomes damaged, adhesion is likely reduced and a cycle of increased risk of leaks and skin damage may occur.
    - Living with a skin disorder can negatively impact a patient’s comfort and ultimately, their quality of life.
  • In a recent study, 45% of people living with a stoma were determined to have a peristomal skin disorder.1In fact, peristomal skin complications are the most common reason ostomy patients visit a WOC nurse.2
    - Patients living with an Ileostomy (57%) and Urostomy (48%) are more likely to experience skin trouble.1
  • In 77% of these cases, contact of stoma effluent on the skin caused the irritation.1 These effluent-induced disorders resulted from failure of the adhesive due to:
    - Leakage under the adhesive plate
    - Erosion of adhesive over time
    - Incorrect application of the adhesive3
  • Perhaps even more alarming is that 80% did not seek professional assistance for their skin trouble.1
    - Patients likely perceive skin irritation, in the peristomal area, to be inevitable and therefore do not seek assistance.

POSSIBLE SKIN PROBLEMS

Condition Causes Description Care Options
       

Irritant dermatitis4
 Irritant dermatitis

Contact with stool or urine, usually from leakage under the pouching system or between the skin barrier and stoma.

Reddened, moist, and painful skin.
  • Consult with your healthcare professional or dermatologist to determine your treatment options
  • Review your product’s application instructions to learn proper usage and self-care techniques.
  • Clean and dry your peristomal skin
  • Use Stomahesive® Protective Powder on raw or highly irritated areas, and AllKare® Protective Barrier Wipes before applying the skin barrier.
  • Re-measure your stoma periodically to ensure you are using the correct size pouch and/or skin barrier.
  • Use ConvaTec Moldable Technology™ skin barriers for a more individualized, custom fit.
       

Allergic contact dermatitis5
 Allergic contact dermatitis

Exposure to materials and chemical compounds that irritate the skin on contact (i.e.,tape, skin barriers, soap, adhesives, powders, pastes, or pouch material).

Redness and irritation in the area covered or treated by a product.
  • Consult with your healthcare professional or dermatologist to determine your treatment options.
  • Alter pouching system or skin care procedure to eliminate product causing the reaction.
       

Yeast infections (fungal candidiasis)4
 Yeast infections (fungal candidiasis)

Leakage, perspiration, antibiotic therapy, or broken skin.

Itchy, bumpy red skin. Potential infection of the vagina, mouth, or intestine.
  • Consult with your healthcare professional or dermatologist to determine your treatment options.
  • Keep area dry.
       

Hyperplasia or pseudoverrucous lesions5
 Hyperplasia or pseudoverrucous lesions

Chronic exposure of the skin to urine.

Raised areas that vary in color from white to light gray, deep red or brown, next to the stoma. May experience bleeding and/or pain.
  • Consult with your healthcare professional or dermatologist to determine your treatment options.
  • Re-measure your stoma to ensure selection of a proper skin barrier size.
  • Use ConvaTec Moldable Technology™ skin barriers for a more individualized fit.
  • For flush or retracted stomas, use an extended-wear convex product.
       

Folliculitis5
 Folliculitis

Inflammation of the hair follicles, usually caused by a Staph infection due to traumatic hair removal in peristomal skin.

Reddened, pinpoint, or infected areas at the base of the hair follicles.
       

Psoriasis5
 Psoriasis

A common skin disorder that can occur underneath pouching systems and skin barriers.

Whitish scaly patches on the palms, scalp, elbows, knees and soles and on the peristomal skin.
  • Consult with your healthcare professional or dermatologist to determine your treatment options.
  • Consider decreasing the frequency of pouch changes, if possible.
       

Pressure ulcer4
 Pressure ulcer

Excessive pressure from an ostomy belt or rigid ostomy appliance.

Painful ulcers due to excessive pressure on the peristomal skin.
  • Consult with your healthcare professional or dermatologist to determine your treatment options.
  • Identify and get rid of the source of pressure.
  • Follow your healthcare professional’s directions for dressing the wound and future applications of your ostomy system.
       

Pyoderma gangrenosum5
 Pyoderma gangrenosum

Skin disease associated with inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.

Irregularly shaped painful infected ulcers with red-to-purple rolled margins. These may be adjacent to the stoma or elsewhere.
  • Consult with your healthcare professional or dermatologist to determine your treatment options.

CONCLUSION

  • Peristomal skin disorders are a primary concern for people caring for an ostomy.
    - 45% of ostomy patients suffer from skin irritation.1
    - Yet only 20% seek assistance to remedy their problems.1
  • Peristomal skin protection is the cornerstone of ostomy management.
  • Prevention is critical to a patient’s success and comfort.
  • Keys to success:
    - A well-sited stoma may reduce skin complications.
    - Good stoma protrusion is important.
    - Patients should be educated on the optimal environment for healthy skin and able to recognize "normal" vs. "non-normal" skin.
    - Maintaining a proper fitting ostomy appliance.
    - And, access to knowledgeable, trained healthcare providers for follow-up care.2

References [+]

  1. Herlufsen P, Olsen AG, Carlsen B, et al. Study of Peristomal Skin Disorders in patients with permanent stomas. British Journal of Nursing. 2006, Vol 15, No 16: 854-862.
  2. Rolstad BS, Erwin-Toth P. Peristomal Skin Complications: Prevention and Management. Ostomy Wound Management [serial online]. 2004 Sep;50(9):68-77. Accessed May 22, 2007.
  3. Herlufsen P, Olsen AG, Carlsen B, Nybaek H, Karlsmark T and Jemec GB. Are Peristomal Skin Disorders Inevitable? Poster presented at: The 16th Biennial Congress of the World Council of Enterostomal Therapists; July 2-6, 2006, Hong Kong.
  4. Allen S, Best R, Butler S, et al. Canadian Ostomy Assessment Guide. A Canadian Consensus. ConvaTec, A Bristol-Myers Squibb Canada Company. 1998.
  5. Colwell JC. Stomal and peristomal complications. In: Colwell JC, Goldberg MT, Carmel JE (eds). Fecal & Urinary Diversions: Management Principles. St. Louis, MO. Mosby 2004:308-325.

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